title: Effects of selective decontamination on gram-negative colonisation, infections and development of bacterial resistance in esophageal resection.
abstract: Patients undergoing an esophageal resection because of carcinoma are at risk of developing postoperative respiratory tract infections. These patients were studied with respect to preceding colonisation with gram-negative bacilli and the effect of selective decontamination (SD) in decreasing this phenomenon, thereby reducing gram-negative infections. We randomised prospectively 114 patients into a test group receiving SD-medication (n = 56) and a control group receiving conventional prophylaxis. Postoperatively, all patients were admitted to the intensive care unit and mechanically ventilated. The preoperative administration of SD-medication resulted in adequate decontamination within 3-4 days in most patients, and SD could prevent gram-negative colonisation and infections effectively. Discontinuation of SD showed gram-negative (re-)colonisation, and resulted in 12 infections in 4 patients having late complications. This indicates that prolonged use in these patients might be beneficial. This new antibiotic prophylaxis proved effective, without causing an increase in bacterial resistance.
authors.affiliation: Department of Surgery, University Hospital Dijkzigt, Erasmus University, Rotterdam, The Netherlands.
authors.forename: G W
authors.initials: GW
authors.lastname: Tetteroo
authors.forename: J H
authors.initials: JH
authors.lastname: Wagenvoort
authors.forename: C
authors.initials: C
authors.lastname: Ince
authors.forename: H A
authors.initials: HA
authors.lastname: Bruining
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D004938:Esophageal Neoplasms / Q000601:surgery*; D006090:Gram-Negative Bacteria; D006801:Humans; D007362:Intensive Care Units; D011183:Postoperative Complications / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents